By John Fraser, MEDNET

The federal government is continuing to develop NHIN, the Nationwide Health Information Network. NHIN has been focused on sharing clinical information between hospitals, clinics and federal agencies. Recently, however, the design of two new standards for NHIN, related to Medicaid insurance eligibility and Medicare quality reporting, has been of focus.

Medicaid is a government program for low income Americans, partially funded by the federal government, and administered and run by each state / territory (there are 54 current Medicaid systems today). Each of these 54 Medicaid programs run eligibility systems to help providers check Medicaid insurance eligibility, ensuring providers properly bill and provide appropriate services for patients. Providers check Medicaid eligibility frequently, since many Medicaid enrollees enter and leave the Medicaid program monthly. Given this turnover, and the number of different Medicaid systems, it has been challenging for providers to directly check Medicaid eligibility within their states and in bordering states.

In 2005, the Center for Medicaid and State Operations (CMSO) within the Department of Health and Human Services (DHHS) developed the MITA program to directly address this issue. The MITA program is a collaboration of all the state Medicaid systems and CMSO to “establish national guidelines for technologies and processes that can enable improved program administration for Medicaid enterprises.”

One MITA-sponsored project is to develop and prototype a national NHIN service that would allow providers to quickly check a patient’s Medicaid status using a single system. This single system service would allow Medicaid providers a secure way to check any one of the 54 Medicaid systems with the click of a mouse (using the Internet). All a provider would need is an Internet connection, proper security credentials and connectivity to a health information exchange that has NHIN connectivity. Once installed, providers could see such benefits as improved patient care, improved cash flow, and an overall improved process from the Medicaid single system service.

Seonho Kim, Chief Architect at MEDNET, is leading the NHIN planning group to develop and test this new Medicaid single system service. MEDNET and Seonho will be demonstrating the Medicaid MITA NHIN service with the Department of Health and Human Services in the upcoming HIMSS conference in Atlanta in March. Please feel free to stop by at the Interoperability Demonstration area to see how this new Medicaid system works, and impact this system would have on healthcare.